July is Bladder Cancer Awareness Month

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The Origins of bladder cancer are not fully understood, one fact is evident: the more people who get tested for it, the more lives that can be saved. Acupath Laboratory’s Dr. Olga Falkowski offers insights on advances in bladder cancer testing.

July is bladder cancer awareness month and although the origins of this disease are not fully understood, one fact is evident: the more people who get tested for it, the more lives that can be saved. Some people put off screening because they are anxious about invasive endoscopies. Men may be especially reluctant; however it is especially critical they be checked since they are most likely to get this disease. A University of Michigan study found that delays in diagnosis confer a nearly 30% increased risk of death. "Patients with less than three months from symptom onset to diagnosis had significantly better chances for survival than those for whom the interval was more than nine months," says Dr. Olga Falkowski, Director of Genitourinary Pathology at Acupath Laboratories, Inc., a New York-based anatomic pathology and cancer genetics laboratory.

The American Cancer Society estimates there will be about 73,510 new cases of bladder cancer in the United States this year with nearly 15,000 deaths resulting. “Scientists don’t know the exact cause of bladder cancer, but they believe that genetic and environmental factors are involved,” adds Dr. Falkowski.

Common symptoms of bladder cancer
Blood in the urine, pain during urination, frequent urination, incontinence, or feeling the need to urinate and not being able to void, may all be indications of bladder cancer. According to the National Institute of Health, lower back pain, weight loss, abdominal pain, fatigue, or bone pain and tenderness can also be symptomatic.

Testing when bladder cancer is suspected
The physician will perform a physical examination, including a rectal and pelvic exam. The doctor may order a combination of diagnostic exams ranging from imaging scans to a bladder biopsy or cystoscopy. During this outpatient procedure, a tiny tube with a small camera attached is inserted through the urethra into the bladder so doctors can examine the inside of the bladder for tumors.

Bladder cancer is often discovered after it has progressed past Stage I because many tests are not sensitive enough to detect the presence of DNA changes or cancerous cells in the earliest stage. Acupath Laboratories uses a molecular test called UroVysion™ (Abbott Molecular, Des Plaines, IL) that can detect the presence of chromosomal abnormalities in voided urine cells isolated from the bladder – a key indicator of bladder cancer – up to six months sooner than other methods and with up to 95% accuracy.

UroVysion™ can be used in conjunction with other clinical laboratory tests (i.e. urine cytology) to increase the sensitivity of detecting malignant tumors, monitor a patient’s response to therapy during treatment, and to identify a recurrence in patients who are in remission. Researchers are now trying to determine if urine tests that identify these DNA changes can help predict the prognosis of bladder cancer patients (which might affect treatment). Scientists are also investigating whether they might be helpful even earlier, to screen for bladder cancer in people without symptoms. One new urine test looks for a substance called telomerase, an enzyme that is found often in cancer cells.

UroVysionTM) uses a process called Fluorescence in situ Hybridization (FISH), in which fluorescent dye-tagged DNA probes are applied to cells; scientists can then examine the cells for the presence of certain chromosomal abnormalities. A recent study demonstrated the value of an automated approach to the analysis of FISH slides: 96.3% of the slides could be reported directly from the automated scan, requiring no manual review of the slide. As part of the research, Acupath Laboratories developed a "flagging" system to identify cases, based on specific criteria that are likely to benefit from further manual review. Automated FISH analysis has the potential to improve laboratory efficiency and to reduce inter-observer and intra-observer variability, resulting in more accurate and reproducible performance.

Risk factors for bladder cancer
Occupation: People exposed to pollution, chemicals or hazardous materials.

Age: People under 40 rarely develop the disease. Approximately 9 out of 10 people are over the age of 55.

Smoking: Smokers are more than twice as likely to suffer from bladder cancer as nonsmokers; smoking is also responsible for nearly half of all bladder cancer deaths.

Race: Caucasians are diagnosed with bladder cancer almost twice as often as African Americans; Latinos have an even lower rate than African-Americans.

Medical history: “Anyone with a family history of the disease and those treated with radiation for previous cancers are at risk,” says Dr. Falkowski. “Recurrence is also common among those who’ve had bladder cancer.”

Gender: Men are three times more likely than women to get the disease, which is the fourth most common cancer diagnosed in men.

Bio: Board-certified in anatomic and clinical pathology, Dr. Olga Falkowski serves as a subspecialist in Uropathology for Acupath Laboratories, Inc.

Acupath Laboratories, Inc. located in Plainview, New York, is an anatomic pathology and cancer genetics laboratory. Acupath's mission is to deliver fast, accurate anatomic pathology, FISH, ISH, flow cytometry, molecular and cytogenetic analysis in a way that enhances the quality of medical care provided by practitioners while minimizing the risk of error. The research and development team continuously innovates, designing up to date methodologies for testing and new ways for doctors to access, exchange, record and analyze medical information. Acupath is committed to improving efficiencies of practice, superior service and greater patient knowledge and satisfaction. Acupath is accredited by the College of American Pathologists (CAP), the Occupational Safety and Health Administration (OSHA), the Joint Commission, and certified by the New York State Department of Health (DOH). http://www.acupath.com.

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